Proteinuria in COVID-19: prevalence, characterization and prognostic role

Huart, Justine; Bouquegneau, Antoine; Lutteri, Laurence; Erpicum, Pauline; Grosch, Stéphanie; Résimont, Guillaume; Wiesen, Patricia; Bovy, Christophe; Krzesinski, Jean-Marie; Thys, Marie; Lambermont, Bernard; Misset, Benoît; Pottel, Hans; Mariat, Christophe; Cavalier, Etienne; Burtey, Stéphane; Jouret, François; Delanaye, Pierre

BACKGROUND: Proteinuria has been commonly reported in patients with COVID-19. However, only dipstick tests have been frequently used thus far. Here, the quantification and characterization of proteinuria were investigated and their association with mortality was assessed. METHODS: This retrospective, observational, single center study included 153 patients, hospitalized with COVID-19 between March 28th and April 30th, 2020, in whom total proteinuria and urinary α(1)-microglobulin (a marker of tubular injury) were measured. Association with mortality was evaluated, with a follow-up until May 7th, 2020. RESULTS: According to the Kidney Disease Improving Global Outcomes staging, 14% (n = 21) of the patients had category 1 proteinuria (< 150 mg/g of urine creatinine), 42% (n = 64) had category 2 (between 150 and 500 mg/g) and 44% (n = 68) had category 3 proteinuria (over 500 mg/g). Urine α(1)-microglobulin concentration was higher than 15 mg/g in 89% of patients. After a median follow-up of 27 [14;30] days, the mortality rate reached 18%. Total proteinuria and urinary α(1)-microglobulin were associated with mortality in unadjusted and adjusted models. This association was stronger in subgroups of patients with normal renal function and without a urinary catheter. CONCLUSIONS: Proteinuria is frequent in patients with COVID-19. Its characterization suggests a tubular origin, with increased urinary α(1)-microglobulin. Tubular proteinuria was associated with mortality in COVID-19 in our restropective, observational study. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40620-020-00931-w.